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P206. Anorectal function and visceral sensitivity in patients with Crohn's disease and perianal fistulas


D. Wasko-Czopnik1, L. Paradowski1

1Medical University of Wroclaw, Department of Gastroenterology and Hepatology, Wroclaw, Poland



Background: Crohn's Disease (CD) is also known as regional enteritis and is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract. Perianal fistulas is a common problem in patients with CD. The aim of our study was to evaluate anorectal function and rectal sensitivity thresholds in patients CD with perianal fistulas.

Methods: In 12 with CD (6 female, 6 male; mean age 50.2, range 26 to 66 years old) and 12 healthy controls (6 female, 6 male; mean age 48, range 24 to 65 years old) anorectal manometry and rectal balloon distension test were conducted using a high-resolution anorectal manometry (HRM) (Sierra Scientific Instruments).

Results: In CD patients 9 persons (75%) have type I dyssynergic defecation, 1 patient (8.3%) type II dyssynergic defecation and 2 patients (16.7%) had normal result of HRM. The maximal anal resting pressure, reflecting the internal anal sphincter function, was significantly higher than that in the controls: 81.3±17.5 mmHg versus 69.7±14.2 mmHg. There were no considerable differences between both the groups neither in the maximal anal squeeze nor in the cough pressures. CD patients had significantly lower first sensation threshold: 24.4±10.8 mL versus 30.0±10.0 mL. Visceral hypersensitivity (rectal pain/discomfort threshold 100 mL) was observed in 80% of CD patients and in none of the controls.

Conclusions: The increased anal resting pressure and rectal hypersensitivity are observed in CD with perianal fistulas. Disturbances in visceral perception may occur at different levels of the brain-gut axis including direct changes in the enteric nervous system according to rectal mucosa and neural plexus damage.